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Making Mental Health a Global Priority
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RECOVERY-FOCUSED
INTERVENTIONS |
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THE LANCET SERIES ON GLOBAL MENTAL
HEALTH
CALLS FOR ADVOCACY AND ACTION
THE
LANCET SERIES ON GLOBAL MENTAL HEALTH was officially
launched on September 3, 2007 at a forum held at King’s College
London’s Waterloo Campus.
The Lancet Series on Global
Mental Health comprises six articles documenting the evidence
base for global mental health, with a focus on low and middle
income countries. The Series culminates with a strident call for
action to the global health community to scale up services for
mental disorders in these countries. The Series was developed by
an international group of mental health and public health
experts, representing academic, policy and society perspectives.
The Lancet
Series on Global Mental Health: Article Collection
Launching a new movement for mental health
“Despite the great attention western countries pay to the mind
and human consciousness in philosophy and the arts, disturbances
of mental health remain not only neglected but also deeply
stigmatised across our societies.”
These are the introductory
words of The Lancet's editor Dr Richard Horton, in a
comment to introduce the
series. He says: “For the most part, these organisations have
done far too little, if anything at all? In the past, The Lancet
has tried to draw attention to mental health services in
particular countries. With a series of papers today from an
internationally diverse Lancet Global Mental Health Group, to
whom we owe a deep debt of thanks, together with a call to
action and a commitment to track and monitor progress across
arrange of mental health indicators in the run up to a global
summit on mental health in 2009, we aim to change this culture
of lost opportunity.”
14% of
global disease burden due to mental disorders
An estimated 14% of the global burden of disease is due to
neuropsychiatric disorders (NPDs). NPDs are the most important
contributors to morbidity among the non-communicable diseases (NCDs)—more
than heart disease, stroke and cancer—mainly due to the
chronically disabling nature of depression, alcohol- and
substance-use disorders, and psychoses. However, their true
burden is likely to be underestimated because of inadequate
appreciation of the connection between mental disorders and
other health conditions.
In the first of a series of six
reviews, titled “No health without
mental health”, Professor Martin Prince, Institute of
Psychiatry, King's College London, UK, and colleagues provide
evidence that mental illnesses increase the risk for developing
many physical illnesses.
Huge
increase in resources for mental health disorders required
worldwide
Scarcity of resources for mental health, inequity in access, and
inefficiencies in their use have serious consequences, the most
direct of which is that people who need care get none. In this
second paper, titled “Resources for
mental health”, Dr Shekhar Saxena, World Health
Organisation, Geneva, Switzerland, and colleagues say that,
especially in low and middle-income countries, government
spending on mental health is far lower than what is needed.
Almost a third of countries worldwide do not have a specified
budget for mental health and one-fifth of those that have, spend
less than 1% of their budget on mental health.
Treating and preventing mental disorders in low-income and
middle-income countries
Depression can be treated effectively in low- and middle-income
countries with low-cost antidepressants or psychological
interventions such as interpersonal therapy, conclude Professor
Vikram Patel, London School of Hygiene and Tropical Medicine,
UK, and colleagues, authors of the
third paper in The Lancet's Global Mental Health
Series. The authors say that such interventions, when delivered
in primary care, are as cost effective as antiretroviral drugs
for HIV/AIDS.
They add that brief
interventions, delivered by primary care professionals, are
effective for the management of hazardous alcohol use and that
low-cost antipsychotic drugs and family focused psychosocial
interventions are effective for the management of schizophrenia.
Mental
health systems in countries: where are we now?
More than 85% of the world's population lives in 153 low- and
middle-income countries (LAMICs), with most of these countries
allocating very scarce financial resources and grossly
inadequate manpower and infrastructure for mental health. In
the fourth paper of the
series, Dr K S Jacob, Department of Psychiatry, Christian
Medical College, Vellore, India, and colleagues conclude:
“Innovative approaches are needed to promote the reality of
mental disorders and efficiently use available resources to
ensure that basic mental health care reaches all individuals.”
The authors say that many
LAMICs lack mental health policy and legislation (around a third
of WHO's 191 member-countries have no mental health laws), and
this deficiency stops them directing their mental-health
programmes and services.
Overcoming barriers to improve mental health services in low-
and middle-income countries
Despite the publication of high-profile reports and promising
activities in several countries, progress in mental health
service development has been slow in most low-income and middle
income countries. In the fifth paper
of the series, Dr Benedetto Saraceno, Director, Department of
Mental Health and Substance Abuse, WHO, Geneva, Switzerland, and
colleagues conclude: “Many of the barriers to progress in
scaling-up of mental health services can be overcome by the
generation of political will for the organisation of accessible
and humane mental-health care.”
They add that advocates for
mental health provision (which includes those with mental-health
disorders and their families) need to come together to deliver
clear, strong messages about what is required.
A call
for action
Every year up to 30% of the population worldwide will suffer
from some form of mental disorder, and at least two-thirds of
those receive inadequate or no treatment, even in countries with
the best resources. The treatment 'gap' approaches 90% in many
developing countries. In this final
paper of six in The Lancet Global Mental Health
Series, The Lancet Global Mental Health Group join together to
call for a scale-up of mental health services worldwide.
The cost of providing services
at the necessary scale is estimated at US$2 per person in
low-income countries and US$3-4 per person in middle-income
countries, which is modest compared with the costs of scaling up
services for other major contributors to the global-disease
burden.
http://www.thelancet.com/online/focus/mental_health/collection
BARRIERS TO IMPROVING MENTAL
HEALTH SERVICES IN LOW AND MIDDLE INCOME COUNTRIES
- The prevailing public health priority agenda and its impact on
funding
- The complexity of and resistance to decentralizing mental
health services
- Challenges in implementing mental health care in primary care
settings
- The limited number and types of human resources trained and
supervised in mental health care
- Frequent lack of public health perspectives in mental health
leadership
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WFMH AND WONCA RELEASE RESULTS OF
NEW INTERNATIONAL SURVEY
UNDERSTANDING
AND DISCUSSING THE MIND-BODY CONNECTION
AIDS IN THE DIAGNOSIS AND MANAGEMENT OF DEPRESSION
Experts call
for doctors and people with depression to break the silence
PARIS, FRANCE, OCTOBER 18,
2007: Eight in ten doctors (84 percent) say their colleagues
need to be educated on the mind-body link while nearly
two-thirds (63 percent) are concerned about misdiagnosing
depressed patients with a pain condition due to possible
confusion around the link that experts agree exists between the
mind and the body , according to the results of a survey
presented today at the European regional meeting of the World
Organisation of Family Doctors (WONCA).
Findings from the
Mind-Body Connection Survey
suggest that understanding and discussing this mind-body
connection can play a vital role in improving diagnosis and the
management of depression for the estimated 121 million people
worldwide who suffer from the condition.
Depression and pain have been
shown to share biological pathways and chemicals, known as
neurotransmitters, within the central nervous system that are
involved in the transmission, regulation and perception of
both emotions and pain.
“These results underline the
importance of understanding the mind-body connection,” commented
Dr. Gabriel Ivbijaro, Chairman of the WONCA Working Party on
Mental Health, which co-commissioned the survey with the World
Federation for Mental Health (WFMH). “Treatment of depression
should address the full range of emotional and painful physical
symptoms in order to achieve remission and reduce the chance of
relapse. We call on doctors to probe their patients for these
symptoms and therefore help people to break their silence,” Dr.
Ivbijaro urged.
Impact of Physician-Initiated Dialogue on Patient Diagnosis
An overwhelming majority of general practitioners or GPs (85
percent) believe understanding the mind-body connection helps
doctors reach diagnosis more quickly. However, far fewer GPs (70
percent) are currently probing for painful physical symptoms as
part of their depression diagnosis. Interestingly, more GPs are
likely to probe for these symptoms if they have a deeper
understanding of the mind-body connection (82 percent of those
who understand the connection compared to 54 percent of those
who do not).
Impact of Physician-Initiated
Dialogue on Depression Management and Recovery
The survey showed that patients whose doctors initiated a
discussion about the emotional and the physical symptoms of
depression saw a positive impact on depression management and
recovery. Nearly nine out of 10 physicians (82 percent) believe
that treating painful physical symptoms is important in
achieving remission, the accepted goal of depression treatment.
Additionally those people with
depression who had discussed the link with their physician:
- understood how their
treatment would work to relieve their symptoms (82 percent
of those who discussed the mind-body connection with their
physician understood how their treatment would work, while
just 67 percent of those who did not discuss the link with
their physicians understood their treatment); and
- believed that treating
both physical and emotional symptoms would help them to
recover more quickly (81 percent of those who discussed the
mind-body connection with their physician believe it is
important to treat both physical and emotional symptoms,
while just 64 percent of those who did not discuss the
connection with their physicians believed in the importance
of treating these symptoms)
Positive Impact of Understanding the Mind-Body Connection
For people with depression, their understanding of the link was
also shown to play a positive role in the management of their
condition. Those who expressed a deeper understanding of the
mind-body connection:
- waited a full one year
less before discussing their symptoms with their GP as
compared with those who did not express such understanding
(those who understood the mind-body connection waited 90
weeks and those who did not understand it waited 148 weeks);
- were more likely to have a
discussion about the connection with their GP (73 percent of
those who understood the mind-body connection discussed the
connection with their GP but only 53 percent of those who
did not understand the connection discussed it with their
GP); and
- were more likely to
believe that treating both emotional and pain symptoms would
help them recover more quickly (91 percent of those who
understood the mind-body connection believed that treating
both emotional and pain symptoms would help them recover
more quickly, while only 61 percent of those who did not
understood the mind-body, believed this)
Preston Garrison, Secretary
General and CEO of the WFMH and co-commissioner of the
Mind-Body Connection
Survey commented, “The WHO
estimates that depression will rank second only to heart disease
by 2020 in terms of global disability , so we urgently call on
groups representing people with depression to embrace the
mind-body connection and encourage others to break the silence
and reduce needless suffering.”
Based on the survey findings, WONCA and WFMH are planning to
provide GPs with an educational program to increase awareness of
the mind-body link and its role in the management and treatment
of depression in the hope of improving diagnosis, treatment and
recovery rates.
The
Mind-Body Connection Survey is part of the WFMH’s
Breaking Through Barriers depression awareness campaign, a
public education initiative designed to improve the worldwide
standard of care in depression. The campaign is co-sponsored by
Eli Lilly and Company and Boehringer Ingelheim and the survey
was commissioned by the WFMH and WONCA in collaboration with Eli
Lilly and Company and Boehringer Ingelheim.
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People with depression
who understand the mind-body connection were defined
as:
Those who strongly
agreed or somewhat agreed to the following
statements:
- There is
medical evidence to prove that your mind has an
impact on how your body feels (mind-body
connection)
- There is a
link between pain and emotional symptoms
- Emotional and
pain conditions often occur together because of
a shared neurological pathway
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GPs who understand the
mind-body connection were defined as:
Those who strongly
agreed or somewhat agreed to the following
statements:
- There is
medical evidence to prove that a mind-body
connection exists
- Serotonin and
noradrenaline are involved in the regulation of
emotional and pain perception
- Emotional and
pain conditions often occur together because of
a shared neurological pathway
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To View the
Mind-Body Connection Survey Results,
click here
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MENTAL HEALTH
CONSUMER / USER COMMITMENT TO WFMH: A STATEMENT FROM THE 2007
WFMH WORLD CONGRESS, HONG KONG, 23 AUGUST 2007
(Mental health service users
and consumers are an important and growing voice within the
global mental health advocacy movement, and are key allies of
WFMH. During the Closing Ceremonies of the 2007 WMFH World
Mental Health Congress in Hong Kong, SAR China, the following
statement prepared by participating service users and consumers
was presented to the assembled Congress delegates)
Presented on behalf of
Consumer, User, Survivor attendees of this Congress
by Janet Meagher (Australia), Orpheus Chi-shing Wong (Hong Kong)
and Ken Udagawa(Japan).
Thank you for this brief
opportunity to address this gathering.
A number consumers present at this Congress have met to
respectfully offer you these thoughts regarding the roles of
consumers in future programs of World Federation for Mental
Health
- How can consumers such as
ourselves, best work with professionals and others in the World
Federation for Mental Health to model best recovery focused
practices and support you to enable the consumer voice be heard
worldwide?
- A few suggestions were ….
- Have WFMH actively seek and promote membership for nationally
focused Mental Health Consumer Organizations across the world.
- Ensure that there is active
encouragement of consumer / user participation at all levels,
particularly in the congresses/ conferences. We have had no
means of coming together, no way of identifying one another, no
room to meet, no place to meet. There is need for a room for
quiet preparation and small get-togethers between consumers /
users and between consumers / users and professionals.
- We strongly concur with
(keynote speaker) Vikram Patel’s belief that not only are we a
resource, but consumers / users are a vital and essential part
of dissemination and evaluation of mental health research and
information, therefore, we need supportive encouragement to
attend, we need to be able to attend with a feeling of safety,
have the ability to communicate with one another and we need to
believe we are a valued part of processes and the proceedings.
We support WFMH to encourage
and enable the collective professionalism and lived experience
of consumers / users to be acknowledged as a resource of WFMH to
disseminate their and our message.
What we bring is the embodiment
and the face of what mental health activity and advocacy is all
about, we are the representation of what we are all advocating
for. Without us you have no role. Like all in the sector we want
to see consumers living their hopes and dreams in every region
of the world. Together we can make this a reality. The key is
action -- Mutual action.
Recovery is possible. Please
join with us in saying this statement
“Recovery is possible.”
Thank You
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Toruń Declaration 2007
Declaration from EUFAMI’s 4th European Congress in Torun,
Poland, 14-16 September 2007
[ News / Press releases / Toruń
Declaration 2007 ]
Updated on September 18, 2007
All the delegates at the
Congress, including representatives from the 50 EUFAMI family
associations from across all parts of Europe, call on all
European National Governments to fully implement the Helsinki
Action Plan which aims to reduce the burden of care on families
and recognises that it is a basic human right for all persons
to have equal opportunities to experience a good quality of
life.
EUFAMI declares that:
In today’s world it is no longer acceptable that people with
mental illness cannot fulfil their potential in society because
of exclusion from social life due to stigmatisation, lack of
employment or occupation, or poor physical health:
- Health care professionals
must recognise that while people with mental illness have to
be actively involved in their own recovery process, family
and friends play an important role too - provided that they
are properly informed, empowered and supported both by
Mental Health Associations and by professionals.
- Health and social care
professionals must attend to physical health needs in
addition to prescribing medications and psychological
treatments, and we earnestly request them to adapt their
training and practices accordingly. Furthermore health and
social care professionals should promote a system of quality
assurance to secure the important goal of remission and
recovery.
- It is essential that there
is good communication between people with mental illness,
their families and friends and the professionals involved in
their care, and that they work in a coordinated way.
It was once a widely held
belief that the earth was the centre of the Universe, until
Nicolaus Copernicus, astronomer and mathematician born in Toruń
declared that on the contrary the earth and the other planets
revolve around the sun . In the same way mental health hospitals
and other services were once the focus of care for people with
mental illness, but now the focus must be firmly on the patient
and family.
Declaration also available
in German, Spanish, Russian and Polish (please go to EUFAMI
website
http://www.eufami.org/index.pl/en/list/1771)
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THESSALONIKI DECLARATION
The
representatives of the Psychiatric Associations of Eastern
Europe and the Balkans, having convened in Thessaloniki, Greece,
for the First East Europe Psychiatric Congress have decided to
declare the following:
Taking into
account
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That the
majority of the countries of Eastern Europe and the Balkans
are suffering from severe economic difficulties
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That the
population of many of the countries of the region have
suffered severe stress due to wars, civil conflicts and
other stressors
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That there are
still in many countries, hundreds of thousands of refugees
and internally displaced persons living in poor conditions
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That many
psychosocial consequences such as PTSD, depression, anxiety,
psychosomatic disorders, substance abuse, violence etc. have
resulted or have been precipitated by stress and require
treatment and prevention of further consequences
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That there is
need for reconciliation in order to prevent
transgenerational transmission of trauma and future
repetition of the spiral of violence among the countries of
the region
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That political
leaders as well as the international scientific community
can contribute substantially to the prevention of future
mass violence and to the protection of mental health of the
populations
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That the
degree of communication and exchange of scientific
information of psychiatrists in the area with their
colleagues in other parts of the world face serious
obstacles, financial and administrative, thus leading to
isolation of the scientific communities of Eastern Europe
and the Balkans
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That the
scientific productivity of psychiatrists working in the area
has been severely curtailed because of the above economic
and other problems
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That there is
great need for the upgrading of scientific knowledge in
Eastern Europe and the Balkans, especially with reference to
scientific areas like Psychiatric Reform, Community
Psychiatry, Prevention, Promotion of Mental Health and
Research
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That there is
great need for scientific input from Eastern Europe and the
Balkans to return to its previous level of excellence for
the benefit of our patients, their relatives and society
We draw the
attention of the International Scientific Community, the World
Psychiatric Association, the World Health Organization, the
political leadership of the World, and all other relevant
International political, non-governmental and scientific
organizations to the above facts and urge them to contribute to
the reconstruction and advancement of the countries of Eastern
Europe and to the upgrading of productivity of their psychiatric
communities, to the benefit of the patients, their relatives and
the societies of Eastern Europe, the Balkans and the World.
Given on 20
September 2007 in Thessaloniki, Greece
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